Sexual and Reproductive Health

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Patient handout

Is your patient pregnant and considering an abortion?

This guide will help you and your patient determine a plan that best suits their needs.

Does the patient have a Primary Care provider and is the patient comfortable seeking abortion support through them?

• YES – Advise the patient to book an appointment with their primary care provider.
• NO – There are various clinics in Hamilton that patients can utilize that accept self-referrals:

Clinic	Contact
Crown Point Midwives	crownpointfhc.ca/midwives-new All pregnancy care appointments are set up through Community Midwives of Hamilton. Interested individuals can contact them at 905-546-5444.
McMaster Termination of Pregnancy Clinic	905-389-5068 womensclinic@hhsc.ca Termination of Pregnancy Clinic – Hamilton Health Sciences
Hamilton Women’s Clinic	905-540-1900 info@hwclinic.org www.hwclinic.org/contact/
Hamilton Birth Control Clinic	905-525-1677 hessvillage@mcimed.com www.hamiltonbirthcontrolclinic.ca

Please advise your patient that while not all clinics listed above will offer abortion procedures within their clinics, they will all work with your patient to identify and discuss options and refer the patient to the correct services.

Once you have explored the request with the patient, you will need to:

• Complete a medical history review
• Conduct a physical exam
• Order an ultrasound (if needed)
• Order blood tests and other relevant pregnancy tests (e.g., STI tests)
• Discuss options with the patient including, family planning, adoption, and abortion. It is imperative that these discussions utilize a pro-choice framework.
• Discuss supports (see resource guide below)

My patient has decided on terminating their pregnancy. What are their options?

Once the patient has decided on terminating their pregnancy, it is important that you discuss their options with them as soon as possible. While their options may be limited due to medical factors (i.e. how far along the pregnancy is, medical complications), it is important to take into account patient preference.

The College of Family Physicians has further abortion resources and information for physicians available.

	Medical Abortion	Surgical Abortion
What is it?	The abortion pill, called Mifegymiso, causes the uterus to expel pregnancy tissue.	A clinician removes the pregnancy tissue for the uterus
How far along in pregnancy can the patient be?	Up to ~11 weeks* *This may vary depending on the clinic	Up to ~24 weeks *This may vary depending on the clinic
What is the process and how long will it take?	Patient will need to take two pills: 1. Mifepristone: this pill, which is taken orally, will cause the pregnancy to detach form the uterine wall. 2. Misoprostol: this tablet can either be consumed orally or inside the vagina can causes the uterus to contract/cramp to expel pregnancy tissue. This tablet is taken 24-48 hours after the first pill.	Depending on the clinic/hospital, you will get general anesthesia (where you are put to sleep) or local anesthesia, painkillers, and conscious sedation (where you are groggy or calmed, but awake). Your cervix is then gently opened and a flexible tube provides gentle suction to remove pregnancy tissue from the uterus (other instruments may be used as well). The abortion procedure takes 2-15 minutes and does not require stitches or cutting.
Is it painful? Will they bleed?	Patients can expect passing clots, bleeding and cramping that is heavier and more painful than a typical period. You may need to discuss pain management options with your patient.	You can expect mild to very strong cramping during the procedure and some light to moderate bleeding and/or spotting. You and your health care team will discuss pain management options, which may include a pain medication prescription.
Where will it happen?	It is important that you discuss a plan of consumption with your patient. You may offer your clinic space, suggest their home or another comfortable environment or refer them to Crown Point Family Health Centre of the Hamilton Women’s Clinic for support while undergoing a medical abortion.	Please see appendix A for a comprehensive summary of the various local clinics and their requirements (gestational age, etc.)

How can I support my patient after their abortion?

Abortion after-care is just as important as any care leading up to and during the abortion in order to assess your patient’s physical and mental health needs.

If your practice does not include post-abortion support, including mental wellness check-ins and counselling, please ensure your patient is referred to appropriate services including the free resources below.

• All-Options, a non-directive counseling phone line, at 1-888-493-0092
• Exhale, a Pro-Voice phone line, at 1-866-4-EXHALE
• Birth Mark, a reproductive doula support service, at 289-799-3157
• Action Canada (Planned Parenthood Canada), at 1-888-642-2725
• Abortion after-care is just as important as any care leading up to and during the abortion in order to assess your patient’s physical and mental health needs.

These are recommended resources, however, we urge you to please be cautious when looking at other resources as they may not be pro-choice and have ulterior motives.

General Supports for before, during, and after an abortion:

Action Canada

Action Canada is Planned Parenthood Canada and utilizes a pro-choice framework. Action Canada runs the Access Line, a 7-day a week toll-free confidential phone and text line. Through the Access Line, you can ask questions, discuss options, and get connected to the right resources. They can help you find providers for your physical, mental and emotional health and wellbeing, organize travel, and find financial supports.

• Phone: 613-241-4474
• Email: info@actioncanadaSHR.org
• Website: Action Canada | Action Canada for Sexual Health and Rights
• Access Line: Call the access line 1‑888‑642‑2725

Birth Mark Support:

The Birth Mark Team provides meaningful reproductive doula support through individualized support, education opportunities and more. The Birth Mark Team runs an Abortion Support Program utilizing a pro-choice framework. Through this program, you can receive emotional and practical support to navigate your needs. These supports include doula support and after abortion emotional support and they can also help you find providers, organize travel, and find financial supports.

• Phone: 289-799-3157
• Email: info@birthmarksupport.com
• Website: Abortion Support Program — Birth Mark

Planned Parenthood Toronto

Planned Parenthood Toronto offers free counselling at any point during your journey. They will also help you navigate your health care needs by connecting you to the right clinics and providers.

• Phone: 416-0961-0113
• Website: Planned Parenthood Toronto – boldly empowering Toronto’s youth

All-Options

All-Options offers a toll-free talking for peer counselling and support across Canada. The supports provided by All-Options include options counselling, support before and after an abortion, and more. All-Options has developed an Abortion Resolution Workbook to help those having a hard time after an abortion experience. You can download the workbook for free here: Abortion Resolution Workbook — PregnancyOptions.info

• Phone: 1-888-493-0092
• Website: All-Options – all-options pregnancy support

Hamilton Birth Control Clinic

The Hamilton Birth Control Clinic offers pregnancy testing, pro-choice counselling, and medical abortions.

• Phone: 905-525-1677
• Email: hessvillage@mcimed.com
• Website: Hamilton Birth Control Clinic

Exhale

Exhale offers a Pro-Voice text and call line to support you without judgement after you’ve had an abortion. Exhale is designed to support you, your decisions, and your emotions.

• Phone: 617-749-2948
• Website: After-abortion Support – Exhale

Housing:

The YWCA has two beds available for those who are pregnant, those who are post-partum or post-abortion.

• If someone wants to access an emergency reproductive care bed, they (or a service provider) can send an email to: reproductivecare@ywcahamilton.org
• Alternatively – you can call the front desk @ YWCA Hamilton 905-522-9922 and provide a safe phone number for us to call back.

Various emergency shelters in the region may provide housing accommodation, however, there are no reserved or guaranteed spaces.

The City of Hamilton (Public Health) has a webpage of resources for health care professionals on Sexual Health and Sexually Transmitted Blood-borne Infections.